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Injury Epidemiology volume 7 , Article number: 2 Cite this article. Metrics details. Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims. We used the Cochran-Armitage test for trend to assess the statistical significance of changes in the prevalence of alcohol and marijuana detected in these homicide victims during the study period. Overall, During the study period, the prevalence of marijuana increased from Marked increases in the prevalence of marijuana were observed in both sexes and across age and racial groups. Marijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Further research is needed to assess the causal role of marijuana use and concurrent use of marijuana and alcohol in homicide victimization. Homicide is a major cause of injury mortality, particularly for black adolescents and young adults Logan et al. Goodman et al. The mechanisms linking alcohol use to increased homicide risk have been studied extensively. For instance, the pharmacological disinhibition model posits that alcohol intoxication impacts the area of the brain responsible for impulse control, judgment and interpretation of social cues, resulting in impulsive or aggressive behaviors Exum Similarly, it is evident that marijuana use impairs cognitive functions, inhibits impulse control, and increases aggressive behaviors Yanowitch and Coccaro ; Temple et al. Moreover, withdrawal from chronic marijuana use may instigate irritability and heighten the risk of conflict and aggression Smith et al. Despite the growing body of evidence linking alcohol and marijuana to homicide victimization, there is a dearth of information about the contemporary trends in the prevalence of alcohol and marijuana among homicide victims in the United States Kuhns and Maguire ; Delaveris et al. Given the increased permissibility and availability of marijuana, it is necessary to closely monitor its potential adverse health consequences, particularly its involvement in injuries. This study assessed time trends in the prevalence of alcohol and marijuana detected in homicide victims in 9 US states from through Violent deaths refer to fatalities resulting from the intentional use of physical force, power, or other means against others or oneself. The prevalence of alcohol and marijuana detected in homicide victims was calculated by the calendar year and victim characteristics. The Cochran-Armitage test for trend was used to assess the statistical significance of trends in binomial proportions of substance positivity analyzed in this study. Data analysis was performed using SAS, version 9. Homicide victims tested for alcohol and drugs were more likely than those not tested to be white The two groups did not differ significantly in age and sex distributions and incident circumstances such as a fight between two people, drug dealing or death due to the firearm that subsequently led to death. Of the 12, homicide victims with toxicological testing results, Among those testing positive for alcohol, the mean BAC was 0. The prevalence of alcohol and marijuana varied significantly with demographic characteristics Table 1. Male victims were more likely than female victims to test positive for alcohol, marijuana, and both substances. Black victims had a considerably higher prevalence of marijuana During the study period, the prevalence of marijuana detected in homicide victims almost doubled, increasing from Due to the divergent trends, the prevalence of marijuana surpassed the prevalence of alcohol in Fig. The prevalence of marijuana increased in both sexes but the increase was more pronounced in female victims from 5. The prevalence of marijuana detected in homicide victims increased across age and racial groups Figs. Our results indicate that the prevalence of marijuana among homicide victims almost doubled during the through study period while the prevalence of alcohol declined slightly. As a result, marijuana has become the most commonly detected substance in homicide victims. Although demographic distributions of alcohol detected in homicide victims are consistent with drinking behavior in the general population, the epidemiologic patterns of marijuana detected in homicide victims differ markedly from the results of the National Survey on Drug Use and Health Azofeifa et al. Specifically, the prevalence of marijuana detected in homicide victims is about three times the prevalence of self-reported past-year marijuana use in the general population and has increased more rapidly than in the general population. Moreover, the age and race gradients in the prevalence of marijuana detected in homicide victims, particularly the excess prevalence detected in adolescent victims and black victims, are much more pronounced than in the general population. These findings are of potential public health significance because previous research has established alcohol use and marijuana use as risk factors for violent death Wolfgang ; Goldstein ; Sampson and Lauristen ; Howell ; Galea et al. If confirmed, results of our study indicate that marijuana is playing an increasingly important role in homicide victimization. The marked increase in the prevalence of marijuana reported in the present study is germane to the growing decriminalization of marijuana NCSL Although medical marijuana laws do not seem to have a measurable impact on adolescent marijuana use, legalizing recreational marijuana is associated with the increased use of marijuana among youth Rusby et al. Given that more states are considering to legalize recreational marijuana, it is necessary to develop surveillance systems for monitoring the exposure and health consequences related to marijuana. This study has several notable limitations. First, toxicological testing and reporting varied by states. The cross-state variations become particularly problematic for those states with independent county coroner systems rather than a centralized medical examiner system. Given that the 9 states studied account for only about Third, the NVDRS does not record the deltatetrahydrocannabinol level and information about the timing and dosage of marijuana use. Hence, positive results of toxicological testing indicate marijuana use but do not necessarily imply marijuana-induced impairment. Fourth, the overall increase in marijuana positivity might be partially attributed to improved toxicological testing procedures and increased marijuana use in the general population as marijuana becomes more permissible and more accessible. Fifth, data on the type of marijuana use medical or recreational were not available. Thus, the marked increase in marijuana in homicide victims reported in this study cannot be attributed to any particular source of marijuana procurement. Finally, we restricted our analysis to the two most commonly used substances — alcohol and marijuana. Other drugs, such as cocaine, amphetamines, and opiates, may also contribute to homicide victimization although they are less frequently detected in homicide victims than alcohol and marijuana. Despite these limitations, this study provides valuable evidence about the upward trends in recent years in the prevalence of marijuana use and concurrent use of alcohol and marijuana detected in homicide victims. A more comprehensive analysis based on the entire NVDRS data system is warranted to corroborate the findings of this study and shed light on other drugs, such as opiates, methamphetamines, and cocaine. There has been a substantial increase in the prevalence of marijuana use detected in homicide victims across demographic groups in the United States between and Since , marijuana has surpassed alcohol to become the most frequently detected substance in homicide victims. During the study period, the prevalence of concurrent use of alcohol and marijuana detected in homicide victims has also increased significantly. Our findings indicate that marijuana use is increasingly detected in homicide victims and that the role of marijuana plays in homicide victimization needs to be rigorously examined. Auckloo M, Davies BB. Post-mortem toxicology in violent fatalities in Cape Town, South Africa: a preliminary investigation. J Forensic Legal Med. Article Google Scholar. Google Scholar. Accessed 26 July Darke S. The toxicology of homicide offenders and victims: a review. Drug Alcohol Rev. Darke S, Duflou J. Toxicology and circumstances of death of homicide victims in New South Wales, Australia J Forensic Sci. Drugs and violent death: comparative toxicology of homicide and non-substance toxicity suicide victims. Non-natural manners of death among users of illicit drugs: substance findings. Forensic Sci Int. Exum ML. Alcohol and aggression: an integration of findings from experimental studies. J Crim Just. Drugs and firearm deaths in New York City, J Urban Health. Goldstein PJ. Homicide related to drug traffic. Bull N Y Acad Med. Alcohol use and interpersonal violence: alcohol detected in homicide victims. Am J Public Health. Prevalence and factors associated with criminal behavior among illicit drug users: a cross-sectional study. Subst Use Misuse. Association of drug and alcohol use with adolescent firearm homicide at individual, family, and neighborhood levels. Hound Labs. How long can marijuana be detected in drug tests? Accessed 18 June Howell JC. Youth gang drug trafficking and homicide: policy and program implications. Juvenile Justice. Perceived prevalence of peer marijuana use: changes among college students before and after Oregon recreational marijuana legalization. Am J Drug Alcohol Abuse. Drug and alcohol use by homicide victims in Trinidad and Tobago, Forensic Sci Med Pathol. A meta-analysis of alcohol toxicology study findings among homicide victims. A meta-analysis of marijuana, cocaine and opiate toxicology study findings among homicide victims. Homicides - United States, MMWR Suppl. PubMed Google Scholar. State medical marijuana laws. Updated July 2, Accessed 1 Aug Inj Epidemiol. Legalization of recreational marijuana and community sales policy in Oregon: impact on adolescent willingness and intent to use, parent use, and adolescent use. Psychol Addict Behav. Sampson R, Lauristen JL. Violent victimization and offending: individual, situational, and community-level risk factors. In: National Research Council, editor. Understanding and preventing violence, volume 3. Marijuana withdrawal and aggression among a representative sample of U. Drug Alcohol Depend. Substance use as a longitudinal predictor of the perpetration of teen dating violence. J Youth Adolesc. Wolfgang M. Victim precipitated criminal homicide. J Crim Law Criminol. Yanowitch R, Coccaro EF. The neurochemistry of human aggression. Adv Genet. Download references. The contents of this article are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services. You can also search for this author in PubMed Google Scholar. ON literature review; analysis, and interpretation of results; drafting of manuscript; critical revision. GL study concept and design; data and funding acquisition; oversight and supervision; interpretation of results; drafting of manuscript; critical revision. Both authors read and approved the final manuscript. Correspondence to Guohua Li. Guohua Li serves as editor-in-chief of the journal, Injury Epidemiology, and was not involved in the review or handling of this manuscript. The authors have no other competing interests to disclose. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions. Nazarov, O. Trends in alcohol and marijuana detected in homicide victims in 9 US states: — Download citation. Received : 26 August Accepted : 11 December Published : 06 January Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract Background Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. Results Overall, Conclusions Marijuana is increasingly detected in homicide victims irrespective of demographic characteristics. Background Homicide is a major cause of injury mortality, particularly for black adolescents and young adults Logan et al. Statistical analysis The prevalence of alcohol and marijuana detected in homicide victims was calculated by the calendar year and victim characteristics. Results Homicide victims tested for alcohol and drugs were more likely than those not tested to be white Full size image. Discussion Our results indicate that the prevalence of marijuana among homicide victims almost doubled during the through study period while the prevalence of alcohol declined slightly. Limitations This study has several notable limitations. Conclusions There has been a substantial increase in the prevalence of marijuana use detected in homicide victims across demographic groups in the United States between and Google Scholar Darke S. Article Google Scholar Hound Labs. Google Scholar Howell JC. Article Google Scholar Wolfgang M. Acknowledgements Not applicable. View author publications. Consent for publication Not Applicable. Competing interests Dr. About this article. Cite this article Nazarov, O. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.

Trends in alcohol and marijuana detected in homicide victims in 9 US states: 2004–2016

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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Brian A. Primack, M. We aimed to determine which media exposures are most strongly associated with marijuana and alcohol use among adolescents. In , we surveyed 1, students at a large high school in suburban Pittsburgh regarding substance use, exposure to entertainment media, and covariates. They reported average exposure to 8. In adjusted models, exposure to music was independently associated with marijuana use, but exposure to movies was independently associated with alcohol use. Implications, limitations, and suggestions for further research are discussed. Keywords: alcohol, marijuana, mass media, entertainment media, adolescence, music, movies, television, video games, books. Adolescents in the United States are currently exposed to media for over 8. This includes substantial engagement with various types of media such as television, films, music, internet, video games, and magazines Rideout et al. Recently, certain media exposures were shown to have significant associations with substance abuse 1 behaviors. In particular, it is now established that viewing smoking-related mass media messages is associated with adolescent smoking initiation Centers for Disease Control and Prevention, ; Dalton et al. Some researchers have even concluded that, based upon established criteria Hill, , the relationship between smoking-related media messages and adolescent smoking is causal DiFranza et al. Fewer studies, however, have examined the relationship between marijuana use and media exposure. Marijuana is the most common illicit drug used by children and adolescents in the United States Heyman et al. More than half of U. Additionally, its use is associated with use of other illicit drugs Raphael, Wooding, Stevens, and Connor, , poor school performance Lynskey and Hall, , depression Degenhardt, Hall, and Lynskey, , and psychosis Arseneault, Cannon, Witton, and Murray, ; Green, Young, and Kavanagh, ; Raphael et al. Although many factors are associated with risk of marijuana use—including genetic predisposition, demographic characteristics, temperament and parenting style Gruber and Pope, ; Hall, ; Heyman et al. Similarly, more studies are necessary to elucidate the relationship between alcohol use and media exposure. Alcohol use is responsible for 75, deaths in the United States each year Stahre, Brewer, Naimi, and Miller, , making it the third leading preventable cause of death Mokdad, Marks, Stroup, and Gerberding, It is considered the leading cause of death in the adolescent years, since it is responsible for a substantial proportion of three major causes of death in this age group: motor vehicle accidents, other accidents, and violence Columbia University Center on Addiction and Substance Abuse, ; Smith, Branas, and Miller, ; Stahre et al. A relationship between alcohol use and media exposure is highly plausible Austin, Chen, and Grube, , and initial evidence suggests that early use of alcohol may be linked to movie exposure Dalton et al. Studies have also shown a relationship between viewing alcohol in advertising and promotions and actual alcohol use in adolescence Austin et al. Several years ago, a series of three content analyses published by the Office of National Drug Control Policy documented that alcohol and marijuana use are portrayed in multiple media, including television, films, music lyrics, and music videos Christenson, Henriksen, and Roberts, ; Roberts, Christenson, Henriksen, and Brandy, ; Roberts, Henriksen, and Christenson, In every case, marijuana was the illicit drug most commonly represented Christenson et al. In contrast, video games seem to contain fewer substance use related messages. The most recent content analysis of M mature rated video games revealed references to illicit drugs in five 3. The most recent content analysis of T-rated teen rated games revealed that none contained references to illegal drugs and that only six 1. There have been important concerns raised regarding the presence of substance use related messages on the internet Ribisl, ; Ribisl, Lee, Henriksen, and Haladjian, For instance, content analyses have revealed that smoking-related Web sites are easily accessible to youth who search for them Ribisl et al. Knowing more about which media exposures are more strongly associated with actual substance use will enable us to focus our research, educational, and policy efforts on the most relevant and important media exposures related to both marijuana and alcohol use. The purpose of this study is to determine the associations between various media exposure types and marijuana and alcohol use in adolescents, after controlling for multiple demographic, intrinsic, and environmental risk factors for substance use. Our a priori hypothesis was that media exposures more likely to contain references to marijuana and alcohol—such as television, films, and music—would be associated with marijuana and alcohol use, whereas exposure to media such as video games, internet, and books with less established substance-related content would not be associated with marijuana and alcohol use. A detailed description of the overall study methodology has been published elsewhere Primack, Gold, Land, and Fine, a ; Primack et al. In brief, in January we surveyed all students at a large suburban high school outside Pittsburgh. We selected this school because it draws from a large region of middle-income families. The min survey assessed media exposure, substance use, and sociodemographic characteristics. The survey was distributed by all social studies teachers on the same day. Prior to the study, we conducted a session with all social studies teachers instructing them how to minimize bias in administration of the survey. Students did not place their names or any other unique identifiers on their surveys. Students were not required to complete the survey for a grade, extra credit, or any other school-based incentive. However, those who completed the survey received a bag of trail mix as thanks for their time. Although there were not enough research personnel to be present in each classroom, two research personnel were continuously available for questions that arose. Since the survey was anonymous, both the University of Pittsburgh IRB and the school superintendent approved the study with opt-out parental informed consent. Although the primary objective of this study was to develop and validate a battery of items measuring the media literacy of individuals, an important secondary goal of the study was to examine the interrelationships between media exposure and adolescent substance use. The high school selected for this study is located in a blue-collar neighborhood about 20 min from the city center of Pittsburgh. Although students at this school are drawn from a relatively wide region, they represent primarily a middle-income population with few families at socioeconomic extremes. The survey consisted of approximately items. It was designed to require no more than 30 min to complete. It was extensively reviewed by experts in public health, adolescent medicine, and psychometrics, and it was pilot tested in a convenient sample of adolescents. It contained empirically based items assessing substance use, media exposures, and covariates. For hours of watching television, we asked respondents for values for an average weekday, an average Saturday, and an average Sunday. We did this for television watching because our pilot studies showed that students were likely to have different responses for television watching on each of these separate days, but that their exposures to the other media were similar across weekdays and weekends. We classified all media exposure measures as categorical variables, consistent with how media exposures are reported in the literature Gidwani, Sobol, DeJong, Perrin, and Gortmaker, ; Gutschoven and Van den Bulck, ; Sargent et al. We selected cut-off points roughly approximating quartiles or quintiles that were appropriate for each media exposure. We assessed several relevant covariates. We also assessed important intrinsic and environmental characteristics of the adolescents including authoritative parenting, stress level, depression, self-esteem, rebellious behavior, and sensation seeking. Although we based our measures on established scales when they were available Blascovich and Tomaka, ; Jackson, Henriksen, and Foshee, ; Kroenke, Spitzer, and Williams, ; Smith and Fogg, ; Zuckerman, Ball, and Black, , we were not able to include all items from each scale because of unacceptable respondent burden. All covariate items are included in the tables. We first performed a descriptive analysis of the valid questionnaires by computing the number of responses to each survey item and calculating the means and standard deviations for continuous variables. We computed these figures in the total sample, among ever users of marijuana, and of ever users of alcohol. We then used chi-squared tests for categorical variables and t -tests for continuous variables to determine which covariates were significantly different in ever users of marijuana versus never users and ever users of alcohol versus never users. Finally, we used bivariate and multivariate logistic regression techniques to assess the association between the dependent variables ever smoking marijuana and ever drinking alcohol and each of the independent variables exposures to each form of media. However, we also ran analyses with all measured covariates in order to test the robustness of our results. We developed a different multivariable model for each of the independent media exposure variables. We searched for significant interactions between media exposure variables and age, sex, and race. Official records show that, of the 1, students enrolled in the school, 1, Of those eligible, 1, The mean age of the 1, respondents was The respondents were exposed to an average of 8. They were exposed to an average of 1. Male and female exposures were similar with the exception of video games: males were exposed to 1. Media exposures, marijuana use, and alcohol use by demographic group a. Unless otherwise specified, table values are in hours per day SD. Based upon parental education. Level 1: At least one parent did not graduate high school. Level 2: Both parents graduated high school but neither graduated college. Level 3: One parent graduated college. Level 4: Both parents graduated college. Nearly all of the measured covariates were significantly related to use of both marijuana and alcohol. Of the covariates, only race was not statistically significantly associated with alcohol use. Unless otherwise noted, items used to measure these characteristics used a four-level Likert scale with responses ranging from strongly agree to strongly disagree. Higher values correspond to more of each characteristic. These p -values were computed with t -tests comparing characteristics in ever users of marijuana with never users of marijuana. These p -values were computed with t -tests comparing characteristics in ever users of alcohol with never users of alcohol. In the fully adjusted and trimmed models, ever using marijuana retained a significant dose—response relationship with music exposure Table 3. All levels of video game exposure above the reference group were associated with lower odds of having ever smoked marijuana. The trimmed multivariate model for marijuana was adjusted for age, gender, race, socioeconomic status, demanding parenting, responsive parenting, stress, sensation seeking, rebelliousness, depression, and school achievement. The trimmed multivariate model for alcohol was adjusted for age, gender, sex, socioeconomic status, demanding parenting, responsive parenting, stress, sensation seeking, rebelliousness, depression, self-esteem, and school achievement. Multivariate results involving alcohol showed that all levels of movie exposure above the reference group were associated with increased odds of ever using alcohol Table 3. Those exposed to two to four movies during the previous 2 weeks versus those with exposure to less than two movies during the previous 2 weeks had odds of 1. We also ran all analyses with untrimmed models including all measured covariates. These results were no different in terms of levels of significance. Specifically, the association between movie exposure and alcohol use was stronger for participants who were 16 years old or younger compared to those who were older than 16 years. The adjusted odds ratio for having tried alcohol for those with the highest level of movie exposure was 3. We find that, after controlling for multiple demographic, intrinsic, and environmental risk factors, marijuana use is independently associated with increased music exposure. In contrast, alcohol was independently associated with increased movie exposure but not music exposure. Finally, we find that exposure to video games and books were associated with reduced odds of having used either substance. Total hours of adolescent media exposure found in this study were also similar to those reported in recent national surveys. In particular, the Kaiser Family Foundation found in that youth are exposed to 8 hr and 33 min of electronic mass media when accounting for multitasking Rideout et al. We found a strong multivariate association between alcohol use and movie exposure but no association between marijuana use and movie exposure. However, it is also possible that there are qualitative differences between the portrayals of the substances. Alternatively, the visual portrayal of alcohol may be more compelling in some way than the visual portrayal of marijuana. It is noteworthy that marijuana use but not alcohol use was independently associated with music exposure in a dose—response fashion, despite the fact that marijuana and alcohol are thought to be equally represented in popular music Roberts et al. There are several potential explanations for the link we found between music exposure and marijuana use. First, it could be that lyrics related to marijuana are currently either more prevalent—or that marijuana is portrayed in more of a positive light in music—than has been previously thought. It will be important to perform new content analyses to answer this question. It is also possible that music induces mood states that predispose to marijuana use, regardless of the presence of references to marijuana. The presence, volume, and type of music played have been shown to affect accessibility of subjects to the use of alcohol and tobacco Gueguen, Guellec, and Jacob, ; Lazev, Herzog, and Brandon, ; McKee, Wall, Hinson, Goldstein, and Bissonnette, ; Willner, Field, Pitts, and Reeve, , but perhaps these elements even more profoundly predispose to marijuana use. Finally, it may be that those who smoke marijuana like to listen to music to enhance their experience, but this is also likely to be true with regard to alcohol. Clearly more investigation into the complex relationship between music exposure and marijuana use is warranted. Interestingly, video game exposure was associated with reduced odds of having used either substance. As previously mentioned, video games contain few if any references to these substances. However, this does not fully explain the lower odds of substance use we observed in video game players. One possibility is that video games tend to be played during times after school and on weekends that might otherwise be spent engaging in risk-taking behavior such as substance use. It is also possible that the time spent playing video games reduces exposure to other forms of media that have more frequent portrayals of alcohol and marijuana use. Thus, while video games may still represent a public health concern in terms of their potential association with aggressive behavior Gentile and Stone, , desensitization to violence Funk, , and attention deficit disorder Chan and Rabinowitz, , they potentially also may represent an activity that removes them from situations leading to substance use. Our finding that exposure to books is associated with less use of either substance will also be important to investigate in more detail. It is unlikely that books contain specific antisubstance use messages. As with video games, it is possible that these activities simply remove students from 1 situations that may lead to substance use; or 2 time spent with other media that portray substance use. However, it is also possible that exposure to books is a marker for an underlying variable or variables for which we did not adequately control. Although we controlled for a number of demographic, intrinsic, and environmental variables, it is certainly possible that other unmeasured covariates exist. Future research should attempt to better characterize this relationship so we can appropriately tap the power of these potentially protective activities. We found one interesting interaction worth considering. Specifically, we found that movie viewing was more significantly associated with alcohol use among younger students 16 or less than among older students. This may suggest that younger adolescents are more susceptible to alcohol-related messages in movies. The differential associations between movie exposure and alcohol in those of different ages should continue to be explored and considered. External generalizability of our findings is limited since our study population was drawn from a single large high school. Another limitation is that we focused on the outcomes of having ever smoked marijuana and having ever used alcohol, so we do not know how these exposures may relate to the frequency of use of these substances. However, we do know that adolescent triers of alcohol and marijuana are at greatest risk for continued use of these substances, and thus having ever tried a substance is a standard outcome for populations in this age range Best et al. Importantly, the cross-sectional design of this study precludes our ability to determine the temporal relationship of the observed associations. Although it is theoretically plausible that media exposure precedes substance use behavior, longitudinal research is needed to definitively determine this. Also, our measure of media use was self-reported did not allow us to specifically quantify exposure to episodes of substance use in the various media studied. Although self-reported frequency of media use is often used in observational studies with large sample sizes Brown et al. Finally, we acknowledge that using statistical models such as these offer only a limited view of what is clearly a much more complex system. It is our hope that future researchers will be able to build upon these results using more complex and nuanced methodologies. We found that marijuana use was linearly and independently related to music exposure but not movie exposure. In contrast, alcohol use was independently associated with movie exposure but not music exposure. This suggests that different forms of media may have varying influences on health risk behaviors. Further research is needed to determine the direction of the relationships and to explore the mechanistic reasons for the diverse associations between various types of media exposure and use of different substances in adolescents. Brian A. Primack , M. After graduating Yale University magna cum laude in with degrees in English literature and mathematics, Dr. Primack combines his expertise in education, technology, human development, and medicine by researching the effect of the mass media messages on health. Specifically, he focuses on the use of media literacy education in preventing adolescent smoking, underage drinking, and other harmful adolescent health behaviors. Kevin L. Kraemer, M. He is a general internist and substance abuse researcher with a special interest in screening and brief intervention and the application of cost-effectiveness and cost-utility analyses to substance abuse prevention and treatment services. He is currently principal investigator of NIH-supported research on improving the quality of care for patients with unhealthy alcohol use and the measurement of utilities for a spectrum of alcohol and drug problems. He serves as co-investigator and site PI for the Veterans Aging Cohort Study, a national observational study of the impact of alcohol and drug abuse on health outcomes in HIV-infected veterans. Michael J. Fine, M. As Director of the VA CHERP, he is particularly interested in conducting research to detect, understand, and eliminate disparities in health and health care among vulnerable patient populations. His past research employed retrospective and prospective cohort designs, with extensive emphasis on assessment of patient-centered outcomes. His current research utilizes randomized clinical trial design to test the effectiveness and safety of medical practice guidelines to improve the quality and efficiency of care for patients with common medical illnesses. Fine has successfully mentored over 25 medical students, residents, fellows, graduate students, and junior faculty, the majority of whom currently hold academic positions. Madeline A. Dalton, Ph. An accomplished scientific researcher in behavioral epidemiology, Dr. She has been Principal Investigator of multiple NIH-funded studies, several of which examine the social and environmental risk factors for tobacco use. Her investigations span from early childhood to adulthood and address a wide range of issues related to smoking prevention, uptake, and progression. For the past 10 years, Dr. Substances are used or misused; living organisms are and can be abused. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. SES c. I do whatever my teacher says to do d. Over the past 2 weeks, how often have you been bothered by these things? I worry that other kids do not like me d.

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